Occipital Neuralgia

What is an Occipital Neuralgia?

The term “Occipital Neuralgia” refers to a rare type of chronic headache disorder. This results from irritation, inflammation, or injury to the occipital nerves. Usually, the occipital nerves run from the top of the spinal cord to the scalp ¹. This causes severe headache with throbbing, piercing, or shock-like pain in the neck, back of the head, or behind the ears. Occipital neuralgia can trigger quickly, even with a simple touch like brushing the hair.

Primary symptoms of occipital neuralgia include sudden, intense, and sharp pain that lasts only a few seconds to a few minutes. People experiencing this pain often suffer from migraines. Migraine pain also lasts much longer than the pain of occipital neuralgia. The pain of occipital neuralgia usually starts from the base of the head and goes to the scalp of one or both sides of the head. Patients may also suffer from intermittent shocking or shooting pain behind the eye of the affected side of the head.

Occipital neuralgia usually occurs because of the pressure or irritation to the occipital nerves due to an injury, inflammation, pinched nerve, or tight muscle around the nerves ². Many times, the causes remain unknown. Several medical conditions can lead to developing occipital neuralgia. These include osteoarthritis, gout, tumors affecting nerve roots, infection, cervical disc disease, diabetes, neck tension, etc.

Occipital neuralgia differs from other types of headache in the types of pain, causes, and areas of pain. Some studies found an association between occipital neuralgia the unremitting head and neck pain (UHNP) ³. A study reported that occipital neuralgia affects almost 3 out of every 100,000 people each year ⁴.

How do Neurosurgeons Diagnose Occipital Neuralgia?

Accurate diagnosis of occipital neuralgia can be difficult due to its similarities with cluster headache and migraines. Patients require to seek medical care if they develop unusual and sharp pain in the neck, scalp, or behind the ear. The initial diagnosis of occipital neuralgia includes a clinical presentation and pain patterns of the patient. Physicians usually press firmly around the back of the head to reproduce the pain. Physicians also perform a brief physical examination and neurological examination to reveal any abnormalities. To confirm the diagnosis, some doctors use occipital nerve blocks. Physicians may further confirm by manual muscle testing, sensory testing, or other imaging techniques. Imaging test may include ¹:

• X-ray: To show any abnormalities in the surrounding structure.
• Electromyography (EMG): Uses electrical impulses to see whether the nerve functions normally.
• Computed tomography (CT or CAT) scan: This test will produce 3D images to show more detail about the shape and size of body structures
• Magnetic resonance imaging (MRI): This shows three-dimensional images of certain body structures and can reveal any damages of soft tissues that cause nerve compression.

How do Neurosurgeons Treat Occipital Neuralgia?

Treatment of occipital neuralgia depends on the cause and symptoms of the patients. The medical team should comprise orthopedics, nerve specialists, and physical therapists while treating a patient with occipital neuralgia. Most patients with occipital neuralgia respond well to non-surgical and conservative treatment. The treatment protocol may include ⁵:

• Ice and heat therapy: Applying hot and cold therapy provides temporary relief from the pain and swelling.
• Medications: Medicines may include pain relievers, muscle relaxants, anticonvulsants, corticosteroids like prednisolone, and nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen to relieve pain and swelling. Botulinum toxin (Botox) injections also decrease the inflammation of the nerve.
• Physical or message therapy: This includes stretching and light exercises that can reduce pressure on the nerves and relieve minor pains.

If patients still face some problems after following the above protocols, physicians may advise to go for surgical options. Surgical treatment for this condition includes occipital nerve stimulation, spinal cord stimulation, ganglionectomy, etc. Contacting the physician can help to select the best options for a patient.

References

1. Choi, I. & Jeon, S. R. Neuralgias of the head: Occipital neuralgia. J. Korean Med. Sci. 31, 479–488 (2016).
2. Juškys, R. & Šustickas, G. Effectiveness of treatment of occipital neuralgia using the nerve block technique: a prospective analysis of 44 patients. Acta medica Litu. 25, 53–60 (2018).
3. Blake, P. & Burstein, R. Emerging evidence of occipital nerve compression in unremitting head and neck pain. J. Headache Pain 20, (2019).
4. Doddamani, R. S. & Meena, R. Management Options in Occipital Neuralgia : A Review . J Peripher Nerve Surg : Management Options in Occipital Neuralgia : A Review. 7–14 (2020) doi:10.1055/s-0040-1716451.
5. Urits, I. et al. A Review of the Recent Findings in Minimally Invasive Treatment Options for the Management of Occipital Neuralgia. Neurol. Ther. 9, 229–241 (2020).